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Original Investigation
February 16, 2017

Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep ApneaA Meta-analysis

Author Affiliations
  • 1Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei
  • 2Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
  • 3Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
  • 4Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan
  • 5Sleep Center, National Taiwan University Hospital, Taipei
JAMA Otolaryngol Head Neck Surg. Published online February 16, 2017. doi:10.1001/jamaoto.2016.4274
Key Points

Question  What effect does lingual tonsillectomy have on polysomnography in children with lingual tonsil hypertrophy and obstructive sleep apnea?

Findings  In this meta-analysis, significant improvements in the apnea-hypopnea index and the minimum oxygen saturation were observed after lingual tonsillectomy. However, children frequently have residual obstructive sleep apnea after lingual tonsillectomy, and postoperative complications must be carefully managed.

Meaning  Lingual tonsillectomy is an effective surgical management for children with obstructive sleep apnea caused by lingual tonsil hypertrophy.

Abstract

Importance  Evidence indicates correlations between lingual tonsil hypertrophy and pediatric obstructive sleep apnea (OSA). However, to our knowledge, a meta-analysis of surgical outcomes for lingual tonsillectomy in children with OSA has not been conducted.

Objective  To evaluate the therapeutic outcomes of lingual tonsillectomy for treatment of pediatric OSA.

Data Sources  The study protocol was registered on PROSPERO (CRD42015027053). PubMed, MEDLINE, EMBASE, and the Cochrane Reviews databases were searched independently by 2 authors for relevant articles published by September 2016.

Study Selection  The literature search identified English-language studies that used polysomnography to evaluate children with lingual tonsil hypertrophy and OSA after lingual tonsillectomy alone. The search keywords were lingual tonsil, lingual tonsillectomy, sleep endoscopy, sleep apnea, and child.

Data Extraction and Synthesis  Polysomnographic data from each study were extracted. A random-effects model pooled postoperative sleep variable changes and success rates for lingual tonsillectomy in treating pediatric OSA.

Main Outcomes and Measures  Four outcomes for lingual tonsillectomy were analyzed. These included net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum oxygen saturation, the overall success rate for a postoperative AHI less than 1, and the overall success rate for a postoperative AHI less than 5.

Results  This meta-analysis consisted of 4 studies (mean sample size, 18.25 patients), with a total of 73 unique patients (mean [SD] age, 8.3 [1.1] years). Fifty-nine percent (27 of 46) of the patients were male, and 1 of the 4 studies did not specify number of males. Lingual tonsillectomy was indicated for persistent OSA after adenotonsillectomy in all cases. Lingual tonsil hypertrophy was evaluated using computed tomography or magnetic resonance imaging in 1 study, sleep endoscopy in 2 studies, and cine magnetic resonance imaging in 1 study. The mean change in the AHI after lingual tonsillectomy was a reduction of 8.9 (95% CI, −12.6 to −5.2) events per hour. The mean change in the minimum oxygen saturation after lingual tonsillectomy was an increase of 6.0% (95% CI, 2.7%-9.2%). The overall success rate was 17% (95% CI, 7%-35%) for a postoperative AHI less than 1 and 51% (95% CI, 25%-76%) for a postoperative AHI less than 5. Postoperative complications that developed included airway obstruction, bleeding, and pneumonia.

Conclusions and Relevance  Lingual tonsillectomy is an effective surgical management for children with OSA caused by lingual tonsil hypertrophy, and it achieves significant improvement in the AHI and the minimum oxygen saturation. However, children frequently have residual OSA after lingual tonsillectomy, and postoperative complications must be carefully managed.

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